Provider Demographics
NPI:1164676367
Name:MARTIN, MARGARET E (ARNP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SOUTHPARK BLVD
Mailing Address - Street 2:SUITE C-300
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5191
Mailing Address - Country:US
Mailing Address - Phone:904-808-7246
Mailing Address - Fax:904-808-7090
Practice Address - Street 1:105 SOUTHPARK BLVD
Practice Address - Street 2:SUITE C-300
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5191
Practice Address - Country:US
Practice Address - Phone:904-808-7246
Practice Address - Fax:904-808-7090
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP632692363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner